This inspection took place on 14 and 15 December 2017 and was announced 48 hours in advance in accordance with the Care Quality Commission's current procedures for inspecting domiciliary care services. This was the first inspection of Advanced Cornwall at their new registered offices.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Advance Cornwall is a domiciliary care service that provides care and support to people in their own homes. This includes people with general physical health needs, mental health needs, and learning disabilities. The care ranges from a few hours of support a week up to 24 hour care for people in supported living.

A supported living service is one where people live in their own home and receive care and support in order to promote their independence. People have tenancy agreements with Advanced Housing and Support Ltd, and receive their care and support from the domiciliary care agency. As the housing and care arrangements are separate, people can choose to change their care provider without losing their home.

Staff were enthusiastic and passionate about the service. Comments included, “I have come to this type of work later in my career and I can honestly say that I love it and find my job very satisfying and rewarding.”

People were supported by a stable and consistent staff team who knew people well and had received training specific to their needs. Staff told us they enjoyed their work and were well supported through supervision, appraisals and training.

People were involved in choosing the staff that supported them. Efforts were made to match staff with people by identifying any shared interests and hobbies.

People told us they felt safe with the staff who supported them. Staff were confident about the action to take if they had any safeguarding concerns and were confident the registered manager would follow up any worries they might have. Risk assessments clearly identified any risk and gave staff guidance on how to minimise the risk. They were designed to keep people and staff safe while allowing people to develop and maintain their independence.

Care records were up to date, had been regularly reviewed and accurately reflected the person's care and support needs. The person's care plan was presented in written and pictorial formats to enable them to read their plan and be involved in any changes or updates. Details of how the person wished to be supported with their care needs were highly personalised and provided clear information to enable staff to provide appropriate and effective support.

Staff had high expectations for people and were positive in their attitude. Staff were respectful of the fact they were working in people's homes. One staff member said "I understand that I am a guest here. I wouldn’t like someone to come into my home without my wishes being respected so that’s always at the front of my mind.”

The service offered flexible support to people and were able to adapt in order to meet people's needs and support them as they wanted. For example, by providing more or less support according to what each person wanted.

The registered managers spoke highly of the staff team describing them as committed and enthusiastic in their approach to work. Staff told us they felt involved in the development of the service and that management listened to any ideas and suggestions they had and took them on board.

The service was well led and all of the staff were motivated and keen to ensure the care needs of the person they were supporting were met. The management team had a clear set of values which was also apparent in our discussions with staff. Advance C